Candidates to Complete Sections A, B and D

Application for election or transfer to class of Fellow Member / Corporate Member / Company Member / Affiliated Member / Associate Member of the HONG KONG INSTITUTE OF STEEL CONSTRUCTION c/o TU743, Department of Civil and Structural Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

Candidates to complete Sections A, B and D. Supporters to provide specimen initials in Section C and to initials those parts of Section D which are appropriate. Applying for election/transfer to Fellow Member/Corporate Member/Company Member/Affiliated Member/Associate Member : (Fire Group / Façade Group / Jointing, Welding and Cold-formed Steel Group) (Delete as appropriate) Section A Complete in block letters or type

Surname Prof/Dr/Ir/Mr/Mrs/Madam/Miss Female/Male

Other Names ID Card No. Chinese Name (if applicable)

Address for Communication

Tel Fax

Residential Address

Tel Fax

Company Name

Tel No.

Fax No.

Date of Birth Age Place of Birth

Section B Obligation and Certificate 1. I, the undersigned, agree that, in the event of my election to the Membership in the HKISC, I will be governed by the Constitution of the HKISC, as it now is, or as it may hereafter be amended. I promise to comply with the Rules of Conduct and promote the objectives of the HKISC as far as I am able. 2. I have / have not* been convicted of a criminal offence within the last seven years. 3. I declare that the above statements on this form are true and correct. 4. Completed application form should be returned to : President, HKISC, c/o TU743, Department of Civil and Structural Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (Fax : 852-23346389, Tel.: 852-2766 6047, email: [email protected]) Note : HKISC stands for the Hong Kong Institute of Steel Construction

Signature of candidate Date Section C Attestation by Supporters

We, the undersigned, support the Candidate from personal knowledge, as a person worthy of consideration for election to the class of Member and we endorse the correctness of those parts of Section D which we have identified by our initials. (See footnote) Initials

Supporter 1 Full Name (in block letters) Prof./Dr./.Ir./Mr./Mrs./Miss*

Address for communication (in block letters)

Tel Professional Qualifications (If any)

HKISC Membership No. Signature

Initials

Supporter 2 Full Name (in block letters) Prof./Dr./.Ir./Mr./Mrs./Miss*

Initials Supporter 3 Full Name (in block letters) Prof./Dr./.Ir./Mr./Mrs./Miss*

 delete as appropriate No. of supporters required Class of Membership Fellow Corporate Member Fellow Being Corporate Member for at least 3 years and supported by (permanent resident) recommended by Three Executive Board Members Corporate Member One Two (permanent resident) Company Member One Two Affiliated Member - Two Associate Member - Two PRIVATE AND CONFIDENTIAL

Section D  All sections to be completed.  Entries to be contained within space provided and typewritten.  Copies to be reduced to A4 size.

From To Academic qualifications Mth/Yr Mth/Yr (Photocopies of documentary evidence must be produced and certified by at least one Supporter as a true copy). University and country Award and date Discipline / Subject studied

Professional Experience, with company names, dates, posts held and exact nature of duties.

Date Professional qualifications (Photocopies* of documentary evidence must be produced and Qualified/Membership certified by at least one Supporter as a true copy). No. (DD/MM/YY)

Current organization Verifying Candidate’s present post tree. Initials______(Please identify your (All supporters) ______position.) Employer______

______

I declare that the statements in Section D are correct.

Candidate’s Signature______

Date______